Daher Contracting, Inc.
786 Beal Parkway NW
Suite 3B
Ft. Walton Beach, Florida 32547
AN EQUAL OPPORTUNITY EMPLOYER
It is the policy of Daher Contracting, Inc. to provide employment
opportunities without regard to race, color, religion, sex,
national origin, age, handicap, or veteran status.
APPLICATION FOR EMPLOYMENT
IMPORTANT: Please fill in your response above each line unless
otherwise indicated. All answers must be printed or typed. Answers that are
illegible or incomplete may prevent us from considering your application.
PERSONAL DATA
______________________________________________________________________
FIRST NAME
MIDDLE
LAST
SOCIAL SECURITY NUMBER
______________________________________________________________________
PRESENT ADDRESS IN FULL
CITY
STATE
ZIP
TELEPHONE
______________________________________________________________________
PERMANENT ADDRESS (IF DIFFERENT)
CITY
STATE
ZIP
TELEPHONE
______________________________________________________________________
ARE YOU LEGALLY AUTHORIZED
TO WORK IN THE UNITED STATES?
YOUR VISA TYPE IF AVAILABLE
DO YOU HAVE A VALID DRIVERS LICENSE?
VISA # AND EXPIRATION DATE
† Yes † No
LICENSE NUMBER: __________ STATE: __________ EXPIRATION DATE: _________
HAVE YOU EVER BEEN CONVICTED OF OR SENTENCED FOR ANY VIOLATION OF THE LAW? † Yes † No
IF YES, GIVE FULL PARTICULARS.
(THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT):
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
POSITION INFORMATION
POSITION APPLIED FOR:
______________________________________________________
REFERRAL SOURCE ADVERTISEMENT (specify):
____________________________
AD NUMBER: ______________
PLACEMENT FIRM (firm name):____________________________________________________
SCHOOL PLACEMENT OFFICE (school name):____________________________________________
OTHER: ___________________________________________________________________________________________________
ARE YOU WILLING TO WORK ANY SHIFT, INCLUDING NIGHTS AND WEEKENDS?
HOW SOON FOLLOWING NOTIFICATION CAN YOU REPORT?
ARE YOU WILLING TO RELOCATE?
† Yes
† Yes † No
____________________
† No
HAVE YOU EVER BEEN EMPLOYED BY THE COMPANY?
† Yes † No
IF YES, WHEN? _______________ WHERE? ____________________________ POSITION?____________________________
ARE ANY RELATIVES, INCLUDING IN-LAWS, EMPLOYED AT THE COMPANY?
IF YES, GIVE NAME, RELATIONSHIP, POSITION AND LOCATION:
† Yes † No
______________________________
________________________________________________________________________
________________________________________________________________________
HAVE YOU EVER PREVIOUSLY APPLIED FOR EMPLOYMENT AT THE COMPANY?
† Yes † No
IF YES, WHEN? (MO.) _______________ (YR.) _______________
HAVE YOU EVER PREVIOUSLY BEEN INTERVIEWED BY THE COMPANY?
† Yes † No
IF YES, WHEN? (MO.) _______________ (YR.) _______________ FOR WHAT POSITION? _____________________________
EDUCATION
_______________________________________________________________________
LAST HIGH SCHOOL ATTENDED/complete address
ATTENDED FROM ________/________ TO ________/________
GRADUATED?
† Yes † No
_______________________________________________________________________
COLLEGE OR UNIVERSITY/complete address
† Yes † No
ATTENDED FROM ________/________ TO ________/________
GRADUATED?
MAJOR _______________________________________________
_____________________
DEGREE RECEIVED
_______________________________________________________________________
COLLEGE OR UNIVERSITY/complete address
† Yes † No
ATTENDED FROM ________/________ TO ________/________
GRADUATED?
MAJOR _______________________________________________
_____________________
DEGREE RECEIVED
_______________________________________________________________________
OTHER (Technical, Vocation, Graduate, etc. complete address)
† Yes † No
ATTENDED FROM ________/________ TO ________/________
GRADUATED?
MAJOR _______________________________________________
_____________________
DEGREE RECEIVED
LIST ANY SCHOLARSHIPS, ACADEMIC HONORS, AWARDS OR SPECIAL ACHIEVEMENTS:
________________________________________________________________________
IN WHAT LANGUAGES OTHER THAN ENGLISH CAN YOU CONVERSE?
________________________________
Fluent?
† Yes † No
________________________________
Fluent?
† Yes † No
________________________________
Fluent?
† Yes † No
EMPLOYMENT HISTORY
IMPORTANT! STARTING WITH YOUR PRESENT OR MOST RECENT EMPLOYER, LIST IN CONSECUTIVE ORDER ALL
EMPLOYMENT AND PERIODS OF UNEMPLOYMENT SINCE YOU GRADUATED FROM OR LAST ATTENDED HIGH
SCHOOL. ADDITIONAL EMPLOYMENT MAY BE LISTED ON A SEPARATE PAGE(S) IF NECESSARY.
PRESENT OR MOST RECENT EMPLOYER
_______________________________________________________________________
FULL NAME OF COMPANY
TELEPHONE
SALARY BEGIN/END
EMPLOYED FROM/TO
_______________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
_______________________________________________________________________
NAME & TITLE OF SUPERVISOR
_______________________________________________________________________
TITLE OF YOUR POSITION
DEPARTMENT
_______________________________________________________________________
DUTIES
_______________________________________________________________________
REASON FOR LEAVING
PREVIOUS EMPLOYER
_______________________________________________________________________
FULL NAME OF COMPANY
TELEPHONE
SALARY BEGIN/END
EMPLOYED FROM/TO
_______________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
_______________________________________________________________________
NAME & TITLE OF SUPERVISOR
_______________________________________________________________________
TITLE OF YOUR POSITION
DEPARTMENT
_______________________________________________________________________
DUTIES
_______________________________________________________________________
REASON FOR LEAVING
PREVIOUS EMPLOYER
_______________________________________________________________________
FULL NAME OF COMPANY
TELEPHONE
SALARY BEGIN/END
EMPLOYED FROM/TO
_______________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
_______________________________________________________________________
NAME & TITLE OF SUPERVISOR
_______________________________________________________________________
TITLE OF YOUR POSITION
DEPARTMENT
_______________________________________________________________________
DUTIES
_______________________________________________________________________
REASON FOR LEAVING
PREVIOUS EMPLOYER
_______________________________________________________________________
FULL NAME OF COMPANY
TELEPHONE
SALARY BEGIN/END
EMPLOYED FROM/TO
_______________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
_______________________________________________________________________
NAME & TITLE OF SUPERVISOR
_______________________________________________________________________
TITLE OF YOUR POSITION
DEPARTMENT
_______________________________________________________________________
DUTIES
_______________________________________________________________________
REASON FOR LEAVING
PREVIOUS EMPLOYER
_______________________________________________________________________
FULL NAME OF COMPANY
TELEPHONE
SALARY BEGIN/END
EMPLOYED FROM/TO
_______________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP CODE
_______________________________________________________________________
NAME & TITLE OF SUPERVISOR
_______________________________________________________________________
TITLE OF YOUR POSITION
DEPARTMENT
_______________________________________________________________________
DUTIES
_______________________________________________________________________
REASON FOR LEAVING
OTHER EMPLOYMENT
LIST PART-TIME EMPLOYMENT WHILE IN SCHOOL, INCLUDING COMPANY NAME(S), ADDRESSES, DATES OF
EMPLOYMENT:
_______________________________________________________________________
_______________________________________________________________________
ARE THERE ANY PERIODS OF UNEMPLOYMENT AND/OR PART-TIME EMPLOYMENT SINCE YOU GRADUATED OR
LAST ATTENDED HIGH SCHOOL WHICH ARE NOT LISTED ABOVE OR ON A SEPARATE SHEET? † Yes † No
IF YES, PLEASE EXPLAIN:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
HAVE YOU EVER BEEN SUSPENDED, PLACED ON PROBATION, ASKED TO RESIGN, DISCHARGED. OR
TERMINATED? † Yes † No
IF YES, PLEASE EXPLAIN:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
MILITARY SERVICE AND STATUS
BRANCH OF SERVICE (IF NONE, STATE NONE): ____________________
MILITARY OCCUPATION: _____________________________________
DATE OF ENTRY INTO ACTIVE DUTY: __________/__________
(MONTH/YEAR)
DATE OF SEPARATION: __________/_________
(MONTH/YEAR)
RANK AT THE TIME OF SEPARATION: _____________________
PLEASE NOTE: FINAL PROCESSING PRIOR TO EMPLOYMENT WILL REQUIRE A REVIEW OF THE ORIGINAL
OR A COPY OF YOUR MILITARY DISCHARGE AND/OR A REVIEW OF YOUR DD FORM 214.
APPLICANT'S CERTIFICATION AND AGREEMENT
I HEREBY CERTIFY that my answers to the foregoing questions are true and complete and that I have not knowingly withheld any
facts, circumstances or other information which would, if disclosed, affect my application. I further understand that any false or
misleading statement or omission of pertinent information will result in the rejection of my application, or in dismissal if discover
subsequent to my employment.
I HEREBY AFFIRM that by execution of the application, I acknowledge that the Company has disclosed to me that an Investigative
Consumer Report, including information as to my character, general reputation, personal characteristics, and mode of living may be
made; and that I, upon written request to the Company made within a reasonable time after the date of this application, may obtain a
complete and accurate disclosure of the nature and scope of the investigation requested.
I HEREBY AUTHORIZE the Company to request, and I ALSO AUTHORIZE AND REQUEST each former employer, school
attended, and each person, firm, or corporation given as references above, to furnish at any time, any information which may be
sought concerning me and my work habits, character or skill, and any other data required, whether in connection with this application
or for purposes of complying with surety company requirements or otherwise.
I HEREBY AFFIRM that by submitting this application I agree to submit to medical evaluations and/or examinations, including tests
for the presence of illegal drugs or alcohol, prior to and during employment, within a time period prescribed by the Company and as
often as directed during employment.
I HEREBY AUTHORIZE the medical examiner to disclose to the Company any and all findings and conclusions arrived at in any
examination performed either prior to employment or during employment.
I UNDERSTAND that should I be given employment, such employment shall be for an indefinite period of time and may be
terminated, at will, at anytime, for any reason, by me or by the Company without notice or without liability whatsoever, except for
unpaid wages or salary earned by the date of termination. I further understand that only the company office of the Company has the
authority to enter into any agreement for employment for a specified period of time or to make any agreement contrary to this at will
standard and that any such agreement must be in writing.
I UNDERSTAND that if I am employed, the terms and conditions of my employment will be governed by this application and the
Company's Terms of Employment and Policy and Procedures, as amended from time to time by the Company.
The Company operates under the principles of affording equal employment opportunity through affirmative action for qualified
handicapped individuals, qualified veterans of the Vietnam era and qualified disabled veterans.
All applicants and employees who believe they to be members of one or more of these groups, and who wish to identify them as such
for the purpose of affirmative action consideration are invited to do so.
Submission of this information is voluntary and refusal to provide it will not subject you to discharge or disciplinary treatment.
Information obtained concerning individuals shall be kept confidential, except that (1) supervisors and managers may be informed
regarding disabled veterans and handicapped individuals, as necessary, (2) first aid and safety personnel may be informed, when and
to the extent appropriate, if the condition might require emergency treatment, and (3) governmental officials investigating compliance
will be informed.
I wish to volunteer the following information (check one)
I do qualify under the following:
† I do not qualify
† Handicapped
† Vietnam Era Veteran
† Disabled Veteran
Signature _______________________________________ Date ________________
Thank you for completing this application. It will remain under consideration for six months. It will not be necessary for you to
reapply during this six month period. Your interest in Daher
Contracting, Inc. is appreciated.